Song Turun, Liao Banghua, Zheng Shuo, Wei Qiang
Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu 610041, Sichuan, People's Republic of China.
Urol Res. 2012 Feb;40(1):67-77. doi: 10.1007/s00240-011-0385-7. Epub 2011 May 15.
The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by stented patients, dysuria (RR = 5.24, P = 0.003); hematuria (RR = 7.28, P = 0.001); loin voiding pain (RR = 5.24, P = 0.003). Postoperative pain score were also higher in patients with stent in the early period after surgery with mean difference 0.95 (P = 0.002). With additional time needed for the placement of stent, the operative time in stented patients were 3.36 min longer than those without stenting (P = 0.02). The additional cost for longer operative room stay, together with the sent and cystoscopic stent removed conditionally, and made the cost for stented patients much higher. No difference were detected in length of hospital stay between both groups (P = 0.22), the stented patients were even of lower rate pay unplanned hospital visit (RR = 0.81, P = 0.55). Stenting did not improve the outcome of patients who underwent ureteroscopic lithotripsy, but associated with increased complication rate. Routinely stenting after ureteroscopic procedure for stone removal was not necessary; however, it still should be reserved conditionally.
本研究旨在评估输尿管镜碎石术后支架置入的必要性。我们对Medline、Embase、Cochrane中心注册的关于输尿管镜术后支架置入与未置入支架取石术比较的随机对照试验进行了系统检索，并对纳入研究的参考文献列表进行了筛选。纳入15项试验，提取相关数据并进行Meta分析。两组在结石清除率和狭窄形成方面未发现差异（P = 0.69；P = 0.67）。置入支架的参与者感染风险高于未置入者，RR = 1.72，但无显著差异。置入支架的患者更常出现与支架相关的下尿路症状，尿痛（RR = 5.24，P = 0.003）；血尿（RR = 7.28，P = 0.001）；腰部排尿痛（RR = 5.24，P = 0.003）。术后早期，置入支架患者的疼痛评分也更高，平均差值为0.95（P = 0.002）。由于放置支架需要额外时间，置入支架患者的手术时间比未置入支架者长3.36分钟（P = 0.02）。手术室停留时间延长带来的额外费用，以及支架置入和有条件的膀胱镜下支架取出，使得置入支架患者的费用更高。两组住院时间无差异（P = 0.22），置入支架患者计划外住院就诊率甚至更低（RR = 0.81，P = 0.55）。支架置入并不能改善输尿管镜碎石术患者的预后，但会增加并发症发生率。输尿管镜取石术后常规置入支架没有必要；然而，仍应视情况有条件保留。
